Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial

OBJECTIVE: To evaluate the cost effectiveness of standard treatment with and without the addition of ward based non-invasive ventilation in patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Incremental cost effectiveness analysis of a randomised controlled trial. SETTING: Medical wards in 14 hospitals in the United Kingdom. PARTICIPANTS: The trial comprised 236 patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease and mild to moderate acidosis (pH 7.25-7.35) secondary to respiratory failure. The economic analysis compared the costs of treatment that these patients received after randomisation. MAIN OUTCOME MEASURE: Incremental cost per in-hospital death. RESULTS: 24/118 died in the group receiving standard treatment and 12/118 in the group receiving non-invasive ventilation (P=0.05). Allocation to the group receiving non-invasive ventilation was associated with a reduction in costs of £49 362 ($78 741; 73 109), mainly through reduced use of intensive care units. The incremental cost effectiveness ratio was £645 per death avoided (95% confidence interval £2310 to £386), indicating a dominant (more effective and less costly) strategy. Modelling of these data indicates that a typical UK hospital providing a non-invasive ventilation service will avoid six deaths and three to nine admissions to intensive care units per year, with an associated cost reduction of £12 000-53 000 per year. CONCLUSIONS: Non-invasive ventilation is a highly cost effective treatment that both reduced total costs and improved mortality in hospital

Sleep disordered breathing following stroke

In recent years there has been increasing interest in the relationship between obstructive sleep apnoea and stroke. It is clear that many patients who have had a stroke have marked obstructive sleep apnoea. This is seen during recovery but also during the acute phase when transient hypoxaemia and the blood pressure swings associated with upper airway obstruction, may worsen the ischaemic penumbra of the area of the brain which is compromised, leading to a worse outcome. There is some evidence to support this hypothesis. This article explores these issues

Scaling in the Lattice Gas Model

A good quality scaling of the cluster size distributions is obtained for the Lattice Gas Model using the Fisher's ansatz for the scaling function. This scaling identifies a pseudo-critical line in the phase diagram of the model that spans the whole (subcritical to supercritical) density range. The independent cluster hypothesis of the Fisher approach is shown to describe correctly the thermodynamics of the lattice only far away from the critical point.Comment: 4 pages, 3 figure

Magnetic-field dependence of electron spin relaxation in n-type semiconductors

We present a theoretical investigation of the magnetic field dependence of the longitudinal ($T_1$) and transverse ($T_2$) spin relaxation times of conduction band electrons in n-type III-V semiconductors. In particular, we find that the interplay between the Dyakonov-Perel process and an additional spin relaxation channel, which originates from the electron wave vector dependence of the electron $g$-factor, yields a maximal $T_2$ at a finite magnetic field. We compare our results with existing experimental data on n-type GaAs and make specific additional predictions for the magnetic field dependence of electron spin lifetimes.Comment: accepted for publication in PRB, minor changes to previous manuscrip

Mode-hop-free tuning over 135 GHz of external cavity diode lasers without anti-reflection coating

We report an external cavity diode laser (ECDL), using a diode whose front facet is not antireflection (AR) coated, that has a mode-hop-free (MHF) tuning range greater than 135 GHz. We achieved this using a short external cavity and by simultaneously tuning the internal and external modes of the laser. We find that the precise location of the pivot point of the grating in our laser is less critical than commonly believed. The general applicability of the method, combined with the compact portable mechanical and electronic design, makes it well suited for both research and industrial applications.Comment: 5 pages, 5 figure

Age and anatomy of the Gongga Shan batholith, eastern Tibetan Plateau, and its relationship to the active Xianshui-he fault

The Gongga Shan batholith of eastern Tibet, previously documented as a ca. 32–12.8 Ma granite pluton, shows some of the youngest U-Pb granite crystallization ages recorded from the Tibetan Plateau, with major implications for the tectonothermal history of the region. Field observations indicate that the batholith is composite; some localities show at least seven crosscutting phases of granitoids that range in composition from diorite to leucocratic monzogranite. In this study we present U-Pb ages of zircon and allanite dated by laser ablation–inductively coupled plasma–mass spectrometry on seven samples, to further investigate the chronology of the batholith. The age data constrain two striking tectonic-plutonic events: a complex Triassic–Jurassic (ca. 215–159 Ma) record of biotite-hornblende granodiorite, K-feldspar megacrystic granite and leucogranitic plutonism, and a Miocene (ca. 14–5 Ma) record of monzonite-leucogranite emplacement. The former age range is attributed to widespread Indosinian tectonism, related to Paleo-Tethyan subduction zone magmatism along the western Yangtze block of south China. The younger component may be related to localized partial melting (muscovite dehydration) of thickened Triassic flysch-type sediments in the Songpan-Ganze terrane, and are among the youngest crustal melt granites exposed on the Tibetan Plateau. Zircon and allanite ages reflect multiple crustal remelting events; the youngest, ca. 5 Ma, resulted in dissolution and crystallization of zircons and growth and/or resetting of allanites. The young garnet, muscovite, and biotite leucogranites occur mainly in the central part of the batholith and adjacent to the eastern margin of the batholith at Kangding, where they are cut by the left-lateral Xianshui-he fault. The Xianshui-he fault is the most seismically active strike-slip fault in Tibet and is thought to record the eastward extrusion of the central part of the Tibetan Plateau. The fault obliquely cuts all granites of the Gongga Shan massif and has a major transpressional component in the Kangding-Moxi region. The course of the Xianshui Jiang river is offset by ∼62 km along the Xianshui-he fault and in the Kangding area granites as young as ca. 5 Ma are cut by the fault. Our new geochronological data show that only a part of the Gongga Shan granite batholith is composed of young (Miocene) melt, and we surmise that as most of eastern Tibet is composed of Precambrian–Triassic Indosinian rocks, there is no geological evidence to support regional Cenozoic internal thickening or metamorphism and no evidence for eastward-directed lower crustal flow away from Tibet. We suggest that underthrusting of Indian lower crust north as far as the Xianshui-he fault resulted in Cenozoic uplift of the eastern plateau

Action research in physical education: focusing beyond myself through cooperative learning

This paper reports on the pedagogical changes that I experienced as a teacher engaged in an action research project in which I designed and implemented an indirect, developmentally appropriate and child‐centred approach to my teaching. There have been repeated calls to expunge – or at least rationalise – the use of traditional, teacher‐led practice in physical education. Yet despite the advocacy of many leading academics there is little evidence that such a change of approach is occurring. In my role as teacher‐as‐researcher I sought to implement a new pedagogical approach, in the form of cooperative learning, and bring about a positive change in the form of enhanced pupil learning. Data collection included a reflective journal, post‐teaching reflective analysis, pupil questionnaires, student interviews, document analysis, and non‐participant observations. The research team analysed the data using inductive analysis and constant comparison. Six themes emerged from the data: teaching and learning, reflections on cooperation, performance, time, teacher change, and social interaction. The paper argues that cooperative learning allowed me to place social and academic learning goals on an even footing, which in turn placed a focus on pupils’ understanding and improvement of skills in athletics alongside their interpersonal development

Spin relaxation in (110) and (001) InAs/GaSb superlattices

We report an enhancement of the electron spin relaxation time (T1) in a (110) InAs/GaSb superlattice by more than an order of magnitude (25 times) relative to the corresponding (001) structure. The spin dynamics were measured using polarization sensitive pump probe techniques and a mid-infrared, subpicosecond PPLN OPO. Longer T1 times in (110) superlattices are attributed to the suppression of the native interface asymmetry and bulk inversion asymmetry contributions to the precessional D'yakonov Perel spin relaxation process. Calculations using a nonperturbative 14-band nanostructure model give good agreement with experiment and indicate that possible structural inversion asymmetry contributions to T1 associated with compositional mixing at the superlattice interfaces may limit the observed spin lifetime in (110) superlattices. Our findings have implications for potential spintronics applications using InAs/GaSb heterostructures.Comment: 4 pages, 2 figure

Mycobacterium pseudoshottsii sp. nov., a slowly growing chromogenic species isolated from Chesapeake Bay striped bass (Morone saxatilis)

A group of slowly growing photochromogenic mycobacteria was isolated from Chesapeake Bay striped bass (Morone saxatilis) during an epizootic of mycobacteriosis. Growth characteristics, acid-fastness and 16S rRNA gene sequencing results were consistent with those of the genus Mycobacterium. Biochemical reactions, growth characteristics and mycolic acid profiles (HPLC) resembled those of Mycobacterium shottsii, a non-pigmented mycobacterium also isolated during the same epizootic. Sequencing of the 16S rRNA genes, the gene encoding the exported repeated protein (erp) and the gene encoding the 65 kDa heat-shock protein (hsp65) and restriction enzyme analysis of the hsp65 gene demonstrated that this group of isolates is unique. Insertion sequences associated with Mycobacterium ulcerans, IS2404 and IS2606, were detected by PCR. These isolates could be differentiated from other slowly growing pigmented mycobacteria by their inability to grow at 37 degrees C, production of niacin and urease, absence of nitrate reductase, negative Tween 80 hydrolysis and resistance to isoniazid (1 mug ml(-1)), p-nitrobenzoic acid, thiacetazone and thiophene-2-carboxylic hydrazide. On the basis of this polyphasic study, it is proposed that these isolates represent a novel species, Mycobacterium pseudoshottsii sp. nov. The type strain, L15(T), has been deposited in the American Type Culture Collection as ATCC BAA-883(T) and the National Collection of Type Cultures (UK) as NCTC 13318(T)

Intercalibration of the barrel electromagnetic calorimeter of the CMS experiment at start-up

Calibration of the relative response of the individual channels of the barrel electromagnetic calorimeter of the CMS detector was accomplished, before installation, with cosmic ray muons and test beams. One fourth of the calorimeter was exposed to a beam of high energy electrons and the relative calibration of the channels, the intercalibration, was found to be reproducible to a precision of about 0.3%. Additionally, data were collected with cosmic rays for the entire ECAL barrel during the commissioning phase. By comparing the intercalibration constants obtained with the electron beam data with those from the cosmic ray data, it is demonstrated that the latter provide an intercalibration precision of 1.5% over most of the barrel ECAL. The best intercalibration precision is expected to come from the analysis of events collected in situ during the LHC operation. Using data collected with both electrons and pion beams, several aspects of the intercalibration procedures based on electrons or neutral pions were investigated